Ventricular Septal Defects

A ventricular septal defect (VSD) is a heart condition that appears in utero or at birth when the wall between the two lower chambers of the heart fails to form fully. As a result, there could be a single hole or more than one hole in the septum (or wall). This causes abnormal blood flow through the heart, potentially leading to pulmonary overcirculation (too much blood flow to the lungs arteries).

There are two sides to the heart, separated by an inner wall known as the septum. A VSD can occur in the wall between the ventricles (or lower chambers of the heart). For many children born with VSD, the opening eventually closes in the first few years of life. Its ability to close depends on VSD location within the wall and the size of the VSD.

Symptoms of a Ventricular Septal Defect

Symptoms may or may not be obvious. A heart murmur may be the only sign. While your child’s doctor may hear the murmur at birth, it may not be possible to hear until your baby is 6 to 8 weeks old. Babies with larger VSDs are more likely to show symptoms at birth than those with atrial septal defects (ASDs). Those who have medium or large VSDs can develop pulmonary overcirculation (too much blood flow to the lung arteries) and congestive heart disease.

If the VSD is large enough and there is pulmonary overcirculation, symptoms usually appear in the first two months of life and may include:

Heart murmur (abnormal heart sound)
Trouble eating or gaining weight (failure to thrive)
Fast breathing or working hard to breathe
Tiring easily
Excessive sweating

Depending on size and location of the opening, symptoms indicating a VSD may not be noticeable until months to years later. A VSD may not apparent until adulthood in rare cases.

Diagnosis of a Ventricular Septal Defect

A heart murmur, which is associated with a ventricular septal defect, is detected by listening to the chest through a stethoscope. Your child’s doctor may hear abnormal heart sounds or a murmur that indicates blood is not flowing smoothly through the heart. Additional exams and tests may be performed to see the size of the opening, determine whether there is more than one abnormal hole and learn how the VSD affects the heart and lungs. These tests include:

Electrocardiogram (EKG/ECG). This is a simple, painless test designed to record the heart’s electrical activity through electrodes attached to the skin. It can also be used to diagnose heart conditions and monitor any problems.
Chest X-ray. X-rays provide yet a different set of images, showing whether the heart is enlarged or the lungs have extra fluid, which is a sign of heart failure.
Pulse Oximetry. This simple test gives an estimate of how much oxygen is in the blood. A small sensor is attached to a finger or toe to measure oxygen levels.
Echocardiography (or Echo). A painless ultrasound uses sound waves to create pictures of the heart. Doctors can see if there are any problems with the heart formation or the way it works. Once diagnosed, your child may have further echo images to monitor changes.
Cardiac Catheterization. This procedure is rarely needed in the case of a VSD, but may be necessary in more complex disease. Done under local anesthesia, cardiac catheterization can be used for diagnosis and/or repair, depending on your child’s VSD. A small, flexible tube is threaded through a vein in the arm, upper thigh or neck. When it is used as a diagnostic step, special dye is injected to allow the doctor to see how the blood flows through the heart and blood vessels. Pressure inside the heart can also be measured to determine if an opening is causing blood to mix from both sides of the heart.

Treatments

While some ventricular septal defects close over time, others require treatment. The most common treatments are:

Careful monitoring. Depending on the diagnosis, doctors may choose to monitor and observe children who have a defect without symptoms of congestive heart disease. This might require regular follow-up and tests to see if the defect closes on its own or gets smaller.
Extra Nutrition. For those babies who are not growing well, extra nutrition or special feedings may be ordered. These could include high-calorie formulas, breast milk supplements or even tube feeding. This is often a temporary step before surgery.
Cardiac Catheterization. An interventional cardiac catheterization is done via a small, flexible tube, threaded through a vein. If the VSD is the right size and in a good location, it could be closed with a device inserted by a catheter that plugs the hole in the septum. Once in place, normal tissue grows in and around the device and no further procedures are required.
Surgery. In some cases, open-heart surgery is needed to repair the VSD. Surgery is frequently suggested when there are major symptoms or if the opening does not close in the first few year of life, and the doctor feels that there would be a benefit from surgery. While your child’s surgeon repairs the defect, a heart-lung bypass machine is used to keep oxygen and blood flowing through the body. Your child may spend five to seven days in the hospital afterwards. While there are some risks of complications and some activity limitations while your child recovers, results are typically very good.

Key Points to Remember

A ventricular septal defect (VSD) is a heart condition that occurs when an opening fails to close between the two lower chambers of the heart.
Symptoms of VSD may appear at birth or the first few months of life, but may not be noticeable until years later.
Heart murmurs, detected by listening to the chest through a stethoscope, are often a sign of ventricular septal defects.
Some children have VSDs that resolve on their own without treatment.
Treatments range from careful monitoring and perhaps extra nutrition, to more invasive procedures, such as cardiac catheterization or surgery

Support Services & Resources

Visit the websites below to find support groups, services and learn more about ventricular septal defects.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

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Adult Congenital Heart Association

This not-for-profit organization supports adults living with congenital heart disease and works with health professionals to distribute helpful information to patients, parents and caregivers.

Centers for Disease Control and Prevention.

Parents and caregivers can find basic information about ventricular septal defects at this U.S. government website, published by the nation’s leading agency for the protection of public health.

MedlinePlus

This U.S. National Library of Medicine website shares health-related content that explains conditions such as ventricular septal defects.

Ventricular Septal Defects Research

Clinical research is vital to understanding possible new treatments and new tests to help with diagnosis. Our pediatric cardiologists participate in many research studies, both at a local and national level including grants from the National Institutes of Health (NIH) Program Project, a major institution studying the cause and treatment of heart conditions. Your child's cardiologist may ask you about your interest in participating in these studies.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

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